Systemic inflammatory response to cemented and uncemented total hip arthroplasty with PMMA bone cement

Polymethylmethacrylate (PMMA) bone cement is a commonly used material in total hip arthroplasty (THA) intervention procedures due to its ability to provide mechanical stability. However, as any other external material implanted in the organism, it imposes certain risks for potentially provoking inflammatory and acute allergic reaction. This study aimed to investigate the organism's systemic inflammatory response in patients undergoing cemented versus uncemented THA. This prospective study included 58 patients aged 72.9 ± 8.8 years (37 females) undergoing primary THA. Participants received either cemented or uncemented femoral stems based on preoperatively established clinical criteria. Serum levels of histamine, CRP, ESR, IL-6, and TNF-α were assessed at two time points: preoperatively and 24 h postoperatively. Postoperative levels of all inflammatory biomarkers increased significantly compared to the baseline assessments (p < 0.001). Patients receiving PMMA bone cemented implantations showed significantly higher levels of histamine and TNF-α (p < 0.001), IL-6, CRP (p = 0.001) and ESR (p = 0.002) compared to the uncemented group. The increase was more pronounced in biological females for IL-6, ESR and CRP. Cemented THA using PMMA bone cement implantation is associated with a stronger systemic inflammatory response compared to uncemented procedures, particularly among female patients. These findings underscore the importance of considering biomaterial-induced inflammation in both surgical planning and postoperative monitoring. Further large-scale, longitudinal studies should follow to evaluate the clinical significance of these immunological changes.Trial is registered at the ClinicalTrials.gov (29/04/2019; ID: NCT03930537) while being part of a series of investigations on the implantation of hip prosthesis encompassing the PhD of Dr. Skender Ukaj.